Tacit and encoded knowledge in the use of standardised outcome
measures in multidisciplinary team decision making:
A case study of in-patient neurorehabilitation

Greenhalgh, J; Flynn, R; Long, AF; Tyson, S

Abstract

This paper explores how multidisciplinary teams (MDTs) balance encoded knowledge, in
the form of standardised outcome measurement, with tacit knowledge, in the form of
intuitive judgement, clinical experience and expertise, in the process of clinical decision
making. The paper is based on findings from a qualitative case study of a multidisciplinary
in-patient neurorehabilitation team in one UK NHS trust who routinely collected standardised
outcome measures. Data were collected using non-participant observation of 16
MDT meetings and semi-structured interviews with 11 practitioners representing different
professional groups. Our analysis suggests that clinicians drew on tacit knowledge to
supplement, adjust or dismiss ‘the scores’ in making judgements about a patients’ likely
progress in rehabilitation, their change (or lack of) during therapy and their need for
support on discharge. In many cases, the scores accorded with clinicians’ tacit knowledge
of the patient, and were used to reinforce this opinion, rather than determine it. In other
cases, the scores, in particular the Barthel Index, provided a partial picture of the patient
and in these circumstances, clinicians employed tacit knowledge to fill in the gaps. In
some cases, the scores and tacit knowledge diverged and clinicians preferred to rely on
their clinical experience and intuition and adjusted or downplayed the accuracy of the
scores. We conclude that there are limits to the advantages of quantifying and standardising
assessments of health within routine clinical practice and that standardised
outcome measures can support, rather than determine clinical judgement. Tacit knowledge
is essential to produce and interpret this form of encoded knowledge and to balance
its significance against other information about the patient in making decisions about
patient care.

Citation

A case study of in-patient neurorehabilitation. Social Science and Medicine, 67, 183-194. https://doi.org/10.1016/j.socscimed.2008.03.006

• Journal Article Type: Article
• Publication Date: Jan 1, 2008
• Deposit Date: Mar 23, 2010
• Journal: Social Science and Medicine
• Print ISSN: 0277-9536
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 67
• Pages: 183-194
• DOI: https://doi.org/10.1016/j.socscimed.2008.03.006
• Publisher URL: http://dx.doi.org/10.1016/j.socscimed.2008.03.006